Multidrug-resistant tuberculosis.

Multidrug-resistant TB is a growing public health problem. Although control of the multidrug-resistant TB epidemic has been achieved in New York City, strains of multidrug-resistant TB are found in nearly every state. Much of the world faces a growing problem with no immediate solution. The treatment habits and policies that have led to this problem persist. New drug development has been almost nonexistent. The current tremendous global interest offers hope, as does the Global Alliance for Tuberculosis Drug Development supported by the Rockefeller Foundation and the Bill and Melinda Gates Foundation. Their mission is to accelerate the discovery and development of new antituberculosis drugs and put them on the market within 10 years, at prices affordable in less-developed countries. As Dr. Reichman notes, "this action will not address the main underlying cause of almost all drug resistance, non-adherence of patients and doctors to recommended regimens." He calls for an equal commitment to improving the capacity of health care workers to use new and older agents correctly, so that they may continue to be effective in the future. Each year brings new, at-risk immigrants to the United States from all regions of the globe. They bring all the TB problems of their countries of origin with them. Foreign-born people will have a significant impact on TB control efforts in the next decade and beyond. TB elimination programs will need to incorporate systems that can adequately address TB within the United States and support national TB programs in developing countries to help them develop the capacity to successfully manage their own TB problems. A review of the drug resistance patterns isolated from foreign-born people should be adequate to convince even skeptics of the need to support global TB programs.